How to Improve Referral Response Time

A hospital discharge planner sends a skilled nursing referral at 10:12 a.m. Although the admission team receives the packet promptly, a response is not provided until late afternoon. During this delay, several issues may arise. Another facility might be contacted first, the hospital could change the discharge plan, or the family may select a different provider. Additionally, team members may assume someone else is handling the case. Thus, referral response time is not just an operational measure; it demonstrates the speed at which a skilled nursing facility can transform a chance into a clear choice. However, speed should not compromise accuracy. Teams must still confirm clinical fit, financial requirements, staffing, equipment, and bed availability. Acceptance should be thorough, with a focus on eliminating unnecessary delays. This guide outlines methods to measure each response stage, identify bottlenecks, and accelerate decision-making. It also helps leaders maintain accuracy while creating a more responsive admissions process.

What Is Referral Response Time?

Referral response time is the time a facility takes to respond after receiving a referral. This response can confirm receipt, ask for more details, or provide a final admission decision. In other words, PointClickCare describes referral response time as the time between the initiation of the referral and the response of the receiving provider, but each facility should have a well-defined c-value. Otherwise, teams could measure different events and report inaccurate results.  For instance, one facility could pause the clock upon confirming receipt of the referral: “Referral received.” Another team, however, can keep monitoring the time until the team agrees or refuses the resident. So, leaders do not have the right to make fair comparisons of those results. For this reason, SNFs are to be separated from the one “measurement” on the clock and replaced with four specific response clocks.

The Four Clocks Behind Every Referral

1. Acknowledgment time is the speed at which the facility acknowledges. This therefore indicates to the referral partners that the admissions team has received their request.
2. Queue time The ‘queue-time’ period runs from when the facility receives a referral until the team begins its review. Then, this measurement reveals how long it takes for leaders to act on referrals.
3. Decision time begins when the facility receives a referral and ends when the team accepts, declines, or conditionally approves it. Therefore, this measurement captures the complete referral turnaround time.
4. Communication time starts with the team’s decision and ends when the hospital receives the result. This measure measures completed reviews that teams failed to communicate in a timely fashion.

These 4 clocks are more revealing than a single clock. In particular, they highlight the slow parts of the process and help leaders see which enhancement is most meaningful.

Why Referral Response Time Matters in Skilled Nursing

Hospital discharge teams typically provide referrals to multiple possible providers. Thus, they must receive prompt responses to facilitate transition and familiarize families. If there’s no action, there’s uncertainty. But facilities can advance the process by requesting specific missing information, for example. Another pending status, however, without explanation, leaves hospital teams without direction. Furthermore, quicker reactions can help build connections between hospitals. Case managers are aware of facilities that communicate clearly and consistently. As a result, this reliability can foster increased confidence in the admissions staff.

The response time to a referral also reveals issues on the inside. For instance, long delays may reveal coverage gaps, too many handoffs, unclear priorities, or repetitive data entry. This means that leaders have opportunities to enhance the overall process rather than assigning responsibility to individual employees. Most of all, quicker responses enable smooth transitions for residents. Families get clarity quicker, and clinical teams have more time to prepare.

The Hidden Difference Between Fast and Responsive

A quick response is not always a helpful answer. For instance, an automatic message sent on receipt does not remedy the referral. Similarly, if the immediate drop is significant, it can lead to a quicker reaction time, but also a drop in admission performance. A responsive admissions process, on the other hand, will quickly provide you with the next actionable step. The team may pose a specific question, give conditional approval, or make a final decision. Therefore, leaders should measure decision quality alongside speed. Ultimately, the best process delivers timely, accurate, and actionable communication.

Stop Relying on One Average

A typical referral time may mask significant performance issues. Some very old cases, for instance, could skew the findings. However, if there are delays in simple referrals, they may mask complex cases. Thus, leaders need to monitor several performance indicators to get the full picture.

Median Response Time

The median is the middle value in a data set. That is, half of the team’s referrals take them half as long as the other half. Thus, this is a reliable indicator of average performance.

90th-Percentile Response Time

The 90th percentile provides insight into the facility’s slower referrals. Thus, management can determine whether any significant group is experiencing delays.

Target Attainment Ratio

Teams use the target attainment ratio to evaluate the number of referrals completed within a set service target. Thus, the leadership will easily be able to ascertain whether the admissions procedure is meeting its targets.

Aging Referral Count

The last metric to be discussed is the number of aging referrals. It calculates the number of open referrals that have passed the defined warning limits. This measure is not like other historical averages.

Segment the Data Before Drawing Conclusions

The overall figure informs executives of what occurred, while segmentation helps them understand the underlying reasons. Leaders should compare performance during business hours with evenings, nights, and weekends. Focusing only on weekday data may cause them to overlook after-hours coverage issues. Next, leaders should compare facilities within a region. They must also consider referral volume, facility capabilities, and case complexity before ranking individual sites. Lastly, team members should review data by source, payer, channel, reviewer, and outcome. Accepted referrals may follow a different process than denied ones, and clinically complex referrals may require more time to review.

Find the Bottleneck Before Adding More Staff

If delays become more common, the leadership team’s immediate reaction is likely to be to hire new members. Nevertheless, this solution might not solve all types of delays. For instance, a slight increase in the referral amount and a doubling of queue time could suggest problems with inefficient routing, prioritization, or scheduling coverage. At the same time, long periods of clinical reviews could signal other issues with the delays. The reviewer may be unable to find the necessary information, or the specialty approval process could take too long.

It is crucial to identify the cause of every single delay by answering the following three questions:

1. Where did the referral spend the most time in the queue?
2. What allowed the referral team to continue moving forward?
3. Would a rule or alert allow triggering that event earlier?

This technique allows the leadership team to relate every initiative to the evidence.

Set Practical Referral Response Targets

There is no one-size-fits-all for a particular response target. The reality is that each facility has different abilities and needs. As such, leaders need to have a unique target for each response clock. The team may be required to respond quickly to the referral. However, depending on the type of referral, the teams may revise the decision target. Each target needs to be defined, measurable, realistic, and tied into the escalation procedure. At the same time, leaders should not set very aggressive targets without an action plan. The employees should be informed what needs to happen when the referral approaches the deadline. For instance, there could be an automatic notification for the reviewer, backup, and the leaders. Finally, the team should set the criteria for halting each clock. This includes differentiating between the waiting period and processing period when the documentation is missing.

Improve Speed Without Sacrificing Decision Quality

The safest improvements remove nonclinical delay. They do not remove necessary judgment.

Create Priority Rules on Urgency

Not all referrals necessarily follow the same order in the review process. Consequently, referrals need to be prioritized based on when discharge is expected, how urgent the clinical situation is, and the capacity available.

Present Reviewers With Decision-Critical Facts

Reviewers waste their precious time if critical information is hidden under many pages. Therefore, it is necessary to create a succinct summary that includes diagnostics, medications, behavior, precautions, wounds, respiratory requirements, therapy documentation, and information about payers. Nevertheless, the reviewers have to review the source document.

Conduct Independent Reviews Simultaneously

The clinical and financial issues do not always necessitate following a specific order. If necessary, simultaneous review may reduce the total time required for decision-making. But it would be best to identify any dependencies between these reviews.

Turn Delay Reasons Into an Improvement Plan

The coverage on any referral against the goal is a great opportunity to learn from it. But the problem with free-text descriptions is that leaders miss some recurring trends. 

First, define the list of turn-delay causes and categorize them. They might include the absence of a clinical history, insurance verification, a specialization, bed availability, equipment requirements, the reviewer’s availability, or medication cost.

Second, analyze the top causes of the delays every week. You need to measure the frequency and duration of each cause.

Finally, implement changes one by one. You can make the schedule, update your reminders, or improve the clarity of the information. Then measure performance before and after implementing each change.

How Flowtrics Supports Faster Referral Responses

With Flowtrics, skilled nursing staff can convert sporadic referrals into a structured, measurable admissions process. First, the tool collects referral packets and transforms key information into clinical data. As a result, reviewers will be able to access critical information more efficiently. Furthermore, Flowtrics facilitates the activities associated with each review. Teams can coordinate activities, track progress, and complete all admission paperwork using a single workflow.

Once a referral is approved, the tool can create the resident in PointClickCare and synchronize all collected information. Consequently, teams can minimize redundant data entry and facilitate the admissions process. Finally, the workflow provides leaders with insights about response times, bottlenecks, open tasks, and general performance. Nevertheless, Flowtrics does not make admission decisions for the facility itself. Rather, it assists qualified teams in making and completing such decisions.

Frequently Asked Questions About Referral Response Time

What is a Good Referral Response Time Target?

The appropriate target for referral response time will depend on urgency, complexity, staffing, operating hours, and partners’ expectations. Each facility needs to define realistic targets for the process.

When Should the Referral Response Clock Begin?

The referral response clock should begin immediately upon the referral’s arrival at the facility via an appropriate channel. If not, starting the clock after someone reads the referral will cause the loss of valuable time.

Does an acknowledgment count as a response?

Yes, an acknowledgment can be considered the initial step in the response stage. Nevertheless, facilities should track the final admission stage separately to distinguish a quick confirmation from a completed assessment.

How can SNFs reduce referral response time?

To start with, the SNFs need to review time spent in the queue and set targets for each stage of the response process. The second step would be to prioritize urgent requests and extract critical information more quickly.

Why Measure Median Rather Than Just the Average?

The median is used to measure typical performance because outliers do not distort it. Nevertheless, it is important to analyze both measures. Together, the median and the average give insight into the performance of referrals.

Will More Efficient Referrals Benefit Hospitals?

Sure. Efficient communication will help hospitals make transition management easier. Furthermore, consistent feedback will indicate that the facility manages referrals efficiently. As a consequence, the relationship between the hospital and the referral team will improve.

Make Every Minute Accountable

Reducing referral response time doesn’t mean pushing teams to make clinical decisions faster. Leaders need to know where the hold-ups are and what causes them. First, substitute a general metric with four distinct clocks. Monitor acknowledgment, queue, decision, and communication time individually. Second, analyze the segmented results and identify the slowest referrals. Finally, determine the root cause of the bottleneck that is causing the most time delays. Above all else, admissions teams need to be quick yet thorough in their work. Successful teams provide fast, accurate responses without skipping necessary steps. 

Flowtrics assists SNFs in uncovering crucial details about referrals, coordinating additional actions, and eliminating unnecessary administrative time delays. Thus, admissions teams will be able to respond more predictably and progress residents who qualify faster. Looking for a way to speed up your admissions process? Schedule your free Flowtrics demo now. See how connected referral processes can help make better decisions.